Interactive Interpreter

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.

For professional reference, research, and education only. Not for diagnosis or medical advice.

RTW-SE Score Interpreter

  • Enter a total score to see its range.

  • 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.
    3.7–4.5Moderate (3.7–4.5)Between the cut-offs; the lower cut-off of 3.7 was associated with partial return to work.
    1–3.6Low (<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 adults on sick leave due to anxiety or depression.

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, often beside symptom measures such as the PHQ-9 and GAD-7.

What does the RTW-SE measure?

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 [2].

How do you give 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

How do you score and interpret the RTW-SE?

Score range: 1–6 (mean of the 11 item ratings). Higher scores indicate greater self-efficacy for return to work.

Cut-offs [2]: ROC analysis in Norwegian adults 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, for example in work-focused CBT
  • 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 [4], with Cronbach's alpha above 0.80 over time and across subgroups [2].
  • Norway [2]: In 626 adults 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 [3]: 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 people with breast cancer [5], and Rasch analysis in stroke survivors supported unidimensionality with person and item reliabilities above 0.8 [6].

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 adults 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: in 168 employees on sick leave for common mental disorders, a rise in RTW-SE during treatment predicted a shorter time to full return to work, over and above psychological symptoms [7]
  • 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

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.

Related

FAQ

  • 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.

References

    1. 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. 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.
    3. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 7.Lagerveld SE, Brenninkmeijer V, Blonk RWB, Twisk J, Schaufeli WB. Predictive value of work-related self-efficacy change on RTW for employees with common mental disorders. Occup Environ Med. 2017;74(5):381–383.

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