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Clinical trials that are designed to help inform practice in the real world are known as pragmatic trials. They are often characterized by a focus on the practical aspects of the study design, such as the recruitment and consent process in adherence, as well as the use of commonly available equipment.

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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which used a variety of investigators and included participants from various geographical areas. This type of heterogeneity that is crucial for pragmatic trials to be reliable and reduce bias in results is also essential. A high degree of heterogeneity, however can result in problems with the trial design.

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The aim of pragmatic trials is to replicate real-life scenarios and to achieve the highest level of validity externally. They are typically ordered by policymakers and practitioners in order to guide their decisions. They can also be used to determine the cause-effect relationship of an intervention with its outcomes. However, they should not, be used to replace the need for explanation studies.

The concept of pragmatism is controversial, and there are concerns about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 proposed an distinction between explanation-based studies, which prove the validity of a physiological or clinical hypothesis, and pragmatic trials that aid in policy and practice decision-making. They also suggested a framework known as PRECIS for pragmatic trials.2 This tool tried to define the characteristics of a practical study, including recruitment, design, delivery of the intervention, and follow-up.

There is a growing increase in the number pragmatic trials published. A recent Medline query that used the words pragmatic and naturalistic, which was restricted to randomised controlled trials (RCTs), returned 34 articles. They are displayed in red on Figure 2. This indicates that the health sciences community is becoming increasingly sensitized to the subject of pragmatics. It is important to note that the majority of these studies were conducted in primary-care settings.