RTW-SE: Return-to-Work Self-Efficacy Questionnaire

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-behavioral 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