1College of Medicine and Health Sciences, China Three Gorges University, YiChang, Hubei, 443000, People’s Republic of China; 2Department of Blood Purification, Yichang Second People’s Hospital, The Affiliated Yichang Hospital of China Three Gorges University, Yichang, Hubei, 443000, People’s Republic of China

Correspondence: Ling Yang, Department of Blood Purification, Yichang Second People’s Hospital, The Affiliated Yichang Hospital of China Three Gorges University, Yichang, Hubei, 443000, People’s Republic of China, Email [email protected]

Abstract: Self-Determination Theory (SDT) posits that satisfying the needs for autonomy, competence, and relatedness enhances motivation, which may influence return to work (RTW) outcomes. However, its specific impact on RTW remains unclear, warranting further investigation.Following PRISMA-ScR guidelines, we searched PubMed, Web of Science, Embase, Scopus, CINAHL and PsycINFO up to September 2025 for studies examining SDT constructs in RTW contexts. Eleven studies met with inclusion, covering diverse work disability populations. Evidence suggests that greater SDT need satisfaction is associated with higher quality motivation and more sustained RTW engagement, potentially reducing RTW duration and improving employment stability. SDT-informed interventions appear to promote need satisfaction and motivational internalization, with Motivational Interviewing and SDT-aligned tele-rehabilitation or organizational supports identified as common effective components. Our findings support SDT as a coherent framework for understanding RTW dynamics and imply that SDT-guided interventions may enhance vocational rehabilitation outcomes across populations. Future multidisciplinary work should develop explicit SDT-based theories, standardized measures, and integrated intervention pathways to optimize RTW trajectories and long-term employment outcomes.

Keywords: return to work, self-determination theory, occupational disability, vocational rehabilitation, motivational interviewing

Introduction

Return to work (RTW), defined as the process of reintegrating individuals into the workforce following recovery from injury or illness,1 is widely recognized as a critical milestone in the restoration of social functioning and the improvement of quality of life among individuals with occupational disabilities.2–4 Work-impaired individuals, defined as those experiencing functional limitations due to medical conditions such as psychiatric disorders, musculoskeletal disorders, cancer, or chronic pain,5 face significant challenges in achieving sustainable RTW. Although successful RTW supports social role reconstruction2,4 and psychological well-being,3,6 epidemiological evidence indicates declining RTW probabilities, from below 50% at 3–6 months post-injury to below 20% after 12 months of work absence.7 These barriers are further compounded by psychological distress and societal stigma, potentially exacerbating suicide risks8–10 and increasing public health burdens.11

Despite the demonstrated promise of multidisciplinary interventions, particularly psychosocial support programs, in mitigating long-term occupational disabilities, the embedding of these approaches within RTW design and evaluation necessitates a more explicit theoretical framework.12,13 Early interventions, based on the Person Environment Occupation Performance model, emphasize self-advocacy for workplace accommodations,14 thereby promoting autonomy in shaping the RTW process.15,16 Worker–manager collaboration and peer support networks are commonly fostered to support belonging and social connectedness, while psychoeducation and cognitive-behavioral therapy are frequently integrated to enhance cognitive functioning and job performance.14 These components can be construed as SDT-inspired, aligning with practices that foster autonomy, relatedness, and competence. The satisfaction of these three basic psychological needs is expected to translate into higher-quality work engagement and longer-term employment stability. However, understanding why these interventions yield effects across diverse populations and contexts necessitates a unified and operationalizable theoretical framework that explains the relationships among psychological motivation, social context, and behavioral outcomes.16

Self-Determination Theory (SDT) provides a concise lens: the fulfillment of the three basic needs—autonomy, competence, and relatedness17 —fuels self-determined motivation and internalization,18 supporting adaptive work behaviors and well-being in RTW settings.19,20 Across domains (work,21 education,22,23 exercise,24,25 health26), need satisfaction is linked to better functioning and reduced burnout;27 in RTW, this translates into greater workplace engagement and performance when needs are met. Thus, SDT-guided interventions may foster intrinsic motivation and proactive work behavior.28

By synthesizing existing evidence through an SDT framework, this review aims to (1) elucidate the mechanisms by which psychological needs and motivation types influence RTW outcomes; (2) evaluate the efficacy of SDT‑informed interventions across populations; and (3) propose evidence‑based strategies to optimize vocational rehabilitation programs, ultimately fostering successful social reintegration for individuals with occupational disabilities.

Methods Study Design

A scoping review was conducted, adhering to the PRISMA-ScR guidelines, to systematically search, screen, extract, and synthesize existing literature, thereby comprehensively mapping SDT within the RTW domain. A structured workflow, as proposed by PRISMA-ScR,29 was followed to ensure transparency and reproducibility in literature searching, screening, data extraction, and result reporting. The aim was to elucidate how SDT has been applied in published RTW studies.

Eligibility Criteria

Explicit inclusion and exclusion criteria were established a priori to ensure relevance and methodological rigor. Inclusion criteria encompassed studies involving all types of occupational disability populations pertinent to RTW (including, but not limited to, chronic illness, traumatic injury, and neurological/musculoskeletal conditions); qualitative, quantitative, or mixed methods designs; formally published journal or conference papers; and publication in English. Exclusion criteria comprised literature not directly related to the research question (eg, unrelated reviews, commentaries, case reports); gray literature, conference abstracts, or unpublished manuscripts not subjected to peer review; and non-English language articles, including those with non-English abstracts or full texts.

Information Sources and Search Strategy

A comprehensive search strategy was devised to identify relevant studies. Information sources included PubMed, Web of Science, Embase, Scopus, CINAHL, and PsycINFO, with searches conducted from database inception through September 2025. The search strategy combined terms related to SDT (eg, Self-Determination Theory, SDT, basic psychological needs, autonomy, relatedness, amotivation, intrinsic motivation, extrinsic motivation) with RTW-related terms (eg, “return to work”, RTW, “vocational rehabilitation”, “occupational rehabilitation”). Search strings were adapted to the syntax of each database.

Study Selection

The study selection followed a two-stage process. During the screening phase, titles and abstracts were assessed by two independent reviewers (KX, Q) to exclude clearly irrelevant items. During the full-text screening phase, potentially eligible articles were evaluated against the predefined inclusion criteria. To ensure quality control, the screening was independently conducted by both reviewers, with disagreements resolved through discussion or adjudication by a third reviewer (J). The PRISMA flow diagram was used to document the search and selection process. An initial pool of 2099 records was identified, 941 duplicates were removed, and following the screening of titles and abstracts, 62 articles underwent full-text review. Of these, 11 met the inclusion criteria and were included in the analysis. The study selection flow is depicted in PRISMA Diagram in Figure 1.30

Figure 1 PRISMA Flow Diagram of the Study Selection Process. This flowchart illustrates the process of identifying, screening, assessing eligibility, and including studies in the current scoping review. The process began with 2099 records identified through database searching. After removing 941 duplicates, 1158 records underwent title and abstract screening, resulting in the exclusion of 1098 records that did not meet the inclusion criteria. Sixty-two (62) full-text articles were assessed for eligibility, of which 51 were excluded with specific reasons (eg, topic divergence, population mismatch). Ultimately, 11 studies were included in the final scoping review. From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med 6(6): e1000097. doi:10.1371/journal.pmed1000097.

Data Charting and Data Extraction

Data were extracted using a standardized form designed to capture key study characteristics, including authors, year of publication, country/region, study design, sample size, SDT application within RTW, and primary outcomes. Data extraction was performed independently by two researchers, with cross-checks of extraction results. Any discrepancies were resolved through discussion or adjudication by a third author to ensure accuracy and consistency.

Data Analysis and Synthesis

Within the scoping-review framework, descriptive and qualitative synthesis were employed to systematically analyze the extracted data. Specifically, attention was directed at describing the types of SDT applications in RTW and the associated outcomes, thereby providing a comprehensive overview of the current state of research in this domain.

Results Studies Included in the Study

A total of 1158 articles were screened at the title and abstract level, and 62 were subsequently screened at the full-text level. Eleven articles met the inclusion criteria and were, therefore, included in this scoping review (Figure 1). Studies spanned multiple countries, including Norway,31–33 Belgium,34–38 the Netherlands,39,40 and the United States,41 although the majority were conducted in Belgium (n = 5).34–38 Study designs varied, encompassing longitudinal studies (n= 2), cross-sectional studies (n= 2), qualitative studies (n=2), intervention studies (n=1), observational longitudinal studies (n=1), and intervention mapping studies (n=2). Table 1 summarizes the publications included in this review. The studies primarily focused on RTW populations, such as vocational rehabilitation participants and employees on long-term sick leave. Sample sizes ranged from 10 to 366 participants.

Table 1 Characteristics of included studies

Exploring the Mechanisms of SDT in RTW

Four studies explored the mechanisms of SDT in the RTW process. Autonomy support and the satisfaction of basic psychological needs were identified as the core mechanisms driving RTW;34 autonomy support enhances autonomous motivation, while need satisfaction promotes actual behavior and sustained engagement through motivational transformation.34,36 Autonomy and the satisfaction of basic psychological needs are core drivers of improved vocational rehabilitation participation and RTW persistence. Shifts in motivational type from controlled to autonomous motivation have the potential to shorten RTW duration and improve psychological well-being.31 Working alliance and autonomy support jointly contribute to high-quality, long-term employment outcomes.41 Vanovenberghe et al34 reported that controlled motivation is associated with shorter RTW duration, whereas frustration of basic needs is associated with longer work disability.

SDT and Need Satisfaction in the Workplace

Three studies examined how need satisfaction promotes autonomous motivation, work engagement, and RTW in the workplace. When workplaces or interventions provide autonomy support, understanding, and recognition, employees’ autonomous motivation and positive work attitudes tend to increase. Conversely, need frustration and a lack of autonomy support can reduce engagement and job satisfaction. Ellingsen-Dalskau et al32,33 demonstrated that care farm environments provide high levels of autonomy support and need fulfillment, contributing to improved functioning and well-being, thereby facilitating return to work.

RTW Intervention Design and Tool Development Guided by SDT

Motivational counseling and online tools were utilized in four studies to enhance the positive supportive behaviors of practitioners and employers during RTW. SDT was employed as the theoretical foundation in two studies, and communication strategies, such as Motivational Interviewing (MI), were integrated to develop an “autonomy-motivation-promoting” intervention framework. Rymenans et al38 developed a motivational counseling training program to enhance practitioners’ ability to support employee autonomy during RTW, thereby promoting autonomous motivation and engagement and improving practitioners’ knowledge, skills, and beliefs regarding motivational counseling. Beerda et al42 developed a web-based intervention tool to strengthen SMEs’ willingness and capacity to support employees returning to work after long-term sick leave.

Discussion

This scoping review systematically synthesizes the theoretical framework and practical implementation pathways of self-determination theory in facilitating RTW interventions for individuals with occupational disabilities, elucidating the core mechanisms through which psychological need satisfaction and motivation internalization drive behavioral outcomes. The findings suggest that SDT provides a valuable lens for understanding and promoting RTW, highlighting the importance of autonomy support, competence development, and relatedness cultivation.

The Impact of Basic Psychological Needs Fulfillment

The satisfaction of basic psychological needs exerts profound influences on key outcomes, including quality of life and occupational adaptation.34,43 Empirical evidence indicates that when these needs are adequately met, individuals with work disabilities demonstrate enhanced intrinsic motivation and self-regulatory capacity,19 facilitating psychological growth18 and proactive engagement in goal-directed work behaviors. Farholm et al31 found that vocational rehabilitation programs aligned with SDT principles led to increases in need satisfaction, autonomous motivation, perceived competence, and well-being. Conversely, persistent frustration of these needs precipitates detrimental psychological consequences. The satisfaction of these three core psychological needs correlates with improved outcomes, including increased intrinsic motivation and enhanced occupational stability for individuals with occupational disabilities.44 Work-disabled individuals experiencing chronic need deprivation exhibit elevated anxiety and depressive symptoms,36 with subsequent increases in controlled motivation driven by external contingencies. This extrinsic regulation pattern correlates with diminished work efficiency and maladaptive coping strategies.45

Vanovenberghe et al’s34 longitudinal investigation of 349 occupationally disabled individuals revealed a significant association between basic psychological need frustration and prolonged RTW duration. The study further found that sustained need deprivation worsens psychological distress, triggering avoidance behaviors (eg, social withdrawal) and substance abuse, thereby establishing a self-perpetuating cycle of occupational dysfunction.

Impact of Motivation Typologies on Return-to-Work Outcomes

Self-determined motivation serves as a psychological catalyst propelling individuals toward occupational reintegration, with motivation quality fundamentally shaping behavioral trajectories and functional outcomes.Motivation-cultivation strategies should be multi-level and personalized, requiring systematic advancement from the individual and team levels to the organizational level.46 The key lies in creating a supportive environment in which employees feel respected and empowered, thereby stimulating intrinsic motivation.46

The configuration of RTW motivation in work-disabled populations is modulated by multifaceted determinants, including demographic characteristics (eg, age, prior work history), health perceptions, affective states (anxiety/depression levels), and self-efficacy beliefs.5 Crucially, motivation type demonstrates differential associations with RTW success metrics, particularly time-to-RTW and employment sustainability.5

Autonomous motivation appears as a pivotal facilitator of sustainable RTW, a conclusion substantiated across multiple study designs. Individuals exhibiting autonomous motivation demonstrate heightened work engagement, psychological well-being,47 and enhanced capacity to derive meaning from occupational activities.17 These findings align with Saar et al’s observation48 that internalized extrinsic motivation (a subtype of autonomous regulation) predicts favorable RTW outcomes, whereas controlled motivation and amotivation correlate with adverse occupational consequences.17

Notably, Vanovenberghe et al’s longitudinal data34 revealed a paradoxical association between controlled motivation and accelerated initial RTW. Work-disabled populations showed elevated controlled motivation scores relative to population norms, potentially attributable to external pressures (eg, financial obligations) driving short-term RTW decisions. However, this motivation pattern carries latent risks: controlled motivation-driven RTW correlates with poorer mental health outcomes, reduced quality of life, and 2.3-fold higher probability of occupational attrition compared to autonomously motivated counterparts.47

The observed motivation dynamics underscore critical intervention opportunities.49 While autonomous motivation demonstrates superior longitudinal efficacy despite requiring longer initial cultivation periods, the plasticity of motivation systems allows strategic transformation from controlled to autonomous regulation.

SDT and Need Satisfaction in the Workplace

Structured, need-supportive work environments have been demonstrated to foster autonomous motivation, thereby facilitating RTW progress and well-being across heterogeneous contexts. These environments are systematically characterized by three core support mechanisms: (1) autonomy support, involving providing meaningful choices and transparent rationales; (2) relatedness support, encompassing social connectedness and interprofessional collaboration; and (3) competence support, focusing on structured task progression and constructive feedback.Empirical evidence consistently indicates that employees prioritize self-direction and autonomy throughout the return-to-work process, with supportive environments playing a critical role in enabling personal agency and workplace ownership.39 Autonomy-supportive interventions, such as care farms, have demonstrated significant potential in generating psychological need satisfaction, directly correlating with enhanced functional outcomes, intrinsic motivation, and overall well-being. Particularly, social support and meaningful engagement emerge as pivotal mechanisms in such contexts.32,33 Moreover, autonomy support can be systematically operationalized in return-to-work dialogues through the strategic integration of Motivational Interviewing communication techniques.38

Existing SDT-informed interventions primarily target specific work-disabled populations, including individuals with chronic musculoskeletal injuries, traumatic brain injury survivors, and other occupationally vulnerable groups. Notably, intervention frameworks extend beyond direct patient engagement to incorporate key stakeholders such as healthcare providers and organizational supervisors, reflecting a systemic approach to vocational rehabilitation. Comparative analyses of SDT-based intervention characteristics highlight tailored strategies for distinct subgroups, emphasizing the necessity of population-specific adaptations.

Motivational Interviewing-Driven Personalization Strategies

In RTW intervention design, Motivational Interviewing (MI) is a patient-centered counseling approach that uses dialogic techniques to promote behavioral change.50 MI is now understood to be most effective for RTW when it supports basic psychological needs, aligning with SDT by fulfilling autonomy, relatedness, and competence to foster internalized motivation.35 A study by Rymenans et al37 found that MI’s effectiveness stems from mechanisms consistent with SDT: meeting autonomy, relatedness, and competence needs all contribute to behavior change. As an operational extension of SDT, MI has established itself as a cornerstone technique for fostering motivation internalization in RTW contexts.37 The MI intervention accelerated RTW and reduced relapse risk, with statistically significant differences between MI and the CAU condition in Kaplan-Meier analyses (RTW:χ2 = 4.09, p < 0.04; relapse: χ2 = 5.01, p < 0.025).35

Qualitative investigations reveal MI’s tripartite action framework: autonomy reinforcement through voluntary RTW decision-making, competence development via graduated workload adjustments, and relatedness cultivation through therapeutic empathy.37 Population-specific adaptations prove essential, as evidenced by Park et al’s cluster trial51 showing 12.1% higher RTW rates among musculoskeletal disorder patients receiving MI-enhanced interventions, contrasted with the necessity for empathy-centered approaches in medically unexplained conditions.

Emerging hybrid models integrating MI with digital health technologies offer new implementation pathways, where mobile app reminders and progress tracking systems can convert transient motivational gains into enduring behavioral change, and may be scaled in SME and health-insurance settings with fidelity monitoring and need-support measures.

However, MI cannot always serve as a standalone approach;52,53 integrating MI with frameworks such as MOHO can provide a more comprehensive understanding of injury and RTW transitions,54 and embedding MI principles into routine rehabilitation protocols—along with context-specific communication strategies—offers a pragmatic path toward sustainable RTW support infrastructures in resource-constrained environments. In addition, the segment on SME employers demonstrates SDT-grounded tool development (clear prompts, communication videos, and practical checklists) to enhance autonomy, competence, and relatedness in workplace RTW processes, while MI-based training for healthcare insurers and supervisors reinforces needs-supportive leadership and clinical communication.55,56

Study Limitations

This review has several limitations. First, its scope was restricted to English-language publications, thereby excluding studies in other languages. Second, the majority of the included studies were descriptive and exploratory. Finally, the heterogeneity of intervention types presented challenges in integrating certain data. Furthermore, future research should focus on developing explicit SDT-based theories, standardized measures, and integrated intervention pathways to optimize RTW trajectories and long-term employment outcomes.

Conclusion

This review demonstrates how SDT-driven approaches achieve theoretical and practical breakthroughs through multi-dimensional evidence integration. The proposed hierarchical need-support model clarifies differential behavioral activation thresholds, where competence development initiates functional adaptation, autonomy reinforcement sustains engagement, and relatedness cultivation provides contextual reinforcement—a dynamic particularly pronounced in collectivist rehabilitation contexts. Technology-mediated interventions successfully compensate for spatial-temporal limitations of conventional rehabilitation, with tele-supervision achieving comparable efficacy to in-person modalities while expanding service accessibility. The operational integration of positive psychology techniques within SDT frameworks yields standardized yet adaptable intervention blueprints, exemplified by mindfulness-enhanced MI protocols that address both motivational and affective rehabilitation barriers. Moving forward, cross-cultural mechanistic studies must quantify need hierarchy variations across sociocultural dimensions, while artificial intelligence applications should focus on real-time MI adaptation through natural language processing and predictive modeling of intervention dosage effects. Such innovations will catalyze the evolution from generalized rehabilitation paradigms to precision support systems, ultimately enhancing social integration trajectories for individuals with occupational disabilities.

Disclosure

The authors report no conflicts of interest in this work.

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