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Trials designed to inform clinical practice in the real world are called pragmatic trials. They are typically focused on practical aspects of the study design, such as recruitment and consent in adherence, as well as the use of commonly available equipment.

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which employed different investigators and participants from different geographic areas. This kind of heterogeneity is necessary for pragmatic trials to be valid and also helps to reduce bias in the results. However excessive heterogeneity could cause issues with the design of the trial.

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The purpose of pragmatic trials is to simulate real-life scenarios and to achieve the highest level of validity externally. They are usually commissioned by policy makers and practitioners to guide their decision-making. They can also be used to determine the causal relationship between an intervention and its effects. However, they should not be used to replace explanatory studies.

The pragmatism idea is controversial, and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanation trials, which prove a physiological or clinical hypothesis, and pragmatic trials that inform policy and practice decisions. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the traits of a pragmatic research study that includes the recruitment, design, and delivery of the intervention and its follow-up.

There is a positive increase in the number pragmatic trials that are published. A recent Medline query that used the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This indicates that the health science community is becoming increasingly sensitized to the issue of pragmatic thinking. It is important to keep in mind that the majority of these studies were conducted in primary care settings.