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Clinical trials that are designed to help inform practice in the real world are referred to as pragmatic trials. They are typically described by their focus on practical aspects of study design, including recruitment and consent, adherence and the use routinely available equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which utilized various investigators and participants from different geographic areas. This kind of heterogeneity, that is crucial for pragmatic trials to be reliable and lessen the chance of bias is also essential. However excessive heterogeneity could cause problems with the design of the trial.

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The goal of pragmatic trials is to mimic real-life scenarios and to achieve the highest level of validity externally. They are usually requested by practitioners and policymakers to guide their decisions. They are also a good way to identify the cause-effect relationship between the intervention and its effects. However, they shouldn't be used to substitute for explanation trials.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials should replace tests for explanations or if they should serve as an addition to them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which prove a physiological hypothesis or clinical hypothesis, as well as pragmatic trials, that inform the practice and policy decision-making. They also proposed the framework for pragmatic trials, which they called PRECIS.2 This tool attempted to define the elements of a pragmatic trial which includes recruitment, design and delivery of the intervention, and monitoring.

There is a positive trend in the number of pragmatic trials that are published. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This indicates that the health sciences community has become more aware of the importance of pragmatic thinking. It is important to keep in mind, however, that the majority of these studies were conducted in primary-care settings.