RTW-SE: Return-to-Work Self-Efficacy Questionnaire
The RTW-SE (Return-to-Work Self-Efficacy Questionnaire) is an 11-item self-report questionnaire that measures a worker's confidence in their ability to return to work while managing health-related symptoms. It is used in occupational rehabilitation and sick-leave management for anxiety, depression, and chronic pain.
RTW-SE Score Interpreter
Between the cut-offs; the lower cut-off of 3.7 was associated with partial return to work.
11 items rated from totally disagree to totally agree; the score is the mean of the 11 items (1–6). Higher scores mean greater return-to-work self-efficacy.
| Mean score (1–6) | Interpretation |
|---|---|
| 4.6+ | High (≥4.6)At or above the upper cut-off, which was associated with full return to work. |
| 3.7–4.5 | Moderate (3.7–4.5)Between the cut-offs; the lower cut-off of 3.7 was associated with partial return to work. |
| 1–3.6 | Low (<3.7)Below the lower cut-off; low return-to-work self-efficacy, which may warrant work-focused support. |
Gjengedal RGH et al. (2021). J Occup Rehabil 31:664–673. ROC-derived post-treatment cut-offs of 3.7 (partial return to work) and 4.6 (full return to work) in patients on sick leave due to anxiety or depression. Educational reference only — not a diagnostic tool.
For reference only — not an assessment, diagnosis, or medical advice. This page provides scoring reference material; interpretation and clinical decisions rest with a qualified clinician.
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 RTW-SE 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
Each item is rated on an agreement scale from "totally disagree" to "totally agree", and the total is the mean of the 11 items, a continuous score from 1 to 6 (Gjengedal et al., 2021).
How to administer the RTW-SE
- 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
RTW-SE scoring and interpretation
Score range: 1–6 (mean of the 11 item ratings). Higher scores indicate greater self-efficacy for return to work.
Cut-offs (Gjengedal et al., 2021): ROC analysis in Norwegian patients on sick leave due to anxiety or depression suggested two post-treatment cut-offs:
- Mean below 3.7: Low return-to-work self-efficacy
- Mean 3.7 to below 4.6: Moderate; the lower cut-off of 3.7 was associated with partial return to work
- Mean 4.6 or above: High; the upper cut-off of 4.6 was associated with full return to work
These cut-offs showed acceptable discrimination and significantly predicted later work status, but they were derived post-treatment in one clinical sample and may not transfer directly to other populations or time points. Use the score interpreter above to check a mean score against them.
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
- Original development: The RTW-SE was developed and validated in the Netherlands for employees with mental health problems (Lagerveld et al., 2010), with Cronbach's alpha above 0.80 over time and across subgroups.
- Norway (Gjengedal et al., 2021): In 626 patients receiving work-focused therapy for common mental disorders, a one-factor solution had high internal consistency (0.91). Scores showed small to moderate negative correlations with depression and anxiety, differed between work-status groups, and pre- and post-treatment scores predicted full return to work at 3, 6 and 12 months.
- Germany (Hansmann et al., 2022): In three samples of employees with mental disorders or musculoskeletal diseases, internal consistency was good to excellent and the scale was sensitive to change, but retest reliability indices were low.
- China: The Chinese version had a Cronbach's alpha of 0.923 and test-retest reliability of 0.799 in breast cancer patients (Wang et al., 2023), and Rasch analysis in stroke survivors supported unidimensionality with person and item reliabilities above 0.8 (Liu et al., 2022).
Limitations
- Not a diagnosis. The RTW-SE is a prognostic and outcome measure of occupational self-efficacy, not a diagnostic tool.
- Cut-offs from one setting. The 3.7 and 4.6 cut-offs come from a single Norwegian sample of patients with common mental disorders, measured post-treatment.
- Self-report. Scores reflect the person's own expectations and can be influenced by mood, workplace conflict and recent events.
- Stability. The German validation found low retest reliability, consistent with self-efficacy being a modifiable state rather than a fixed trait.
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
This library is an academic and clinical reference. A scale described here is not necessarily offered in HiBoop; each page says whether it is.
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 tool. 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
In the US, the RTW-SE: Return-to-Work Self-Efficacy Questionnaire is usually billed under these CPT codes. Payer rules vary.
Using this assessment in practice
For clinicians
Send it as a gentle check-in before the session. The score is waiting when you open the chart, and the trend builds itself.
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.
References
- 1.Lagerveld SE, Blonk RWB, Brenninkmeijer V, Wijngaards-de Meij L, Schaufeli WB. Work-focused treatment of common mental disorders and return to work: a criterion groups validation study. J Occup Rehabil. 2010;20(2).
- 2.Gjengedal RGH, Lagerveld SE, Reme SE, Osnes K, Sandin K, Hjemdal O. 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. J Occup Rehabil. 2021;31(3):664–673.View source
- 3.Hansmann M, Beller J, Maurer F, Kröger C. Self-Efficacy Beliefs of Employees with Mental Disorders or Musculoskeletal Diseases after Sickness-Related Absence: Validation of the German Version of the Return-to-Work Self-Efficacy Scale. Int J Environ Res Public Health. 2022;19(16):10093.View source
- 4.Lagerveld SE, Blonk RWB, Brenninkmeijer V, Schaufeli WB. Return to work among employees with mental health problems: development and validation of a self-efficacy questionnaire. Work Stress. 2010;24(4):359-375.View source
- 5.Wang T, Jin M, Zhu R, Zheng L, Wang D, Zhao X, Zhao X. Return-to-work self-efficacy questionnaire: Cross-cultural adaptation and validation in China. Nurs Open. 2023;10(9):6336-6344.View source
- 6.Liu F, Zhang Z, Lin B, Ping Z, Mei Y. Assessing the psychometric properties of the Chinese return-to-work self-efficacy questionnaire using Rasch model analysis. Health Qual Life Outcomes. 2022;20(1):27.View source
Last reviewed: Jun 3, 2026
Related Assessments
Explore complementary clinical tools and screeners