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Trials designed to inform clinical practice in the real world are known as pragmatic trials. They are usually characterized by a focus on practical aspects of the study design, including the recruitment process and consent as well as adherence to the use of routinely available equipment.

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Another example of a trial that is pragmatic is the Home Blood Pressure Management (HBPM) study, which employed a variety of investigators and had participants from different geographical regions. This type of heterogeneity which is vital for a pragmatic trial to be reliable and to reduce bias in the results is also essential. However, too much heterogeneity, can cause problems with the design of the trial.

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Pragmatic trials are designed to replicate real-life situations and attain maximum external validity. Usually, they are requested by practitioners and policymakers to guide their decisions. They can also be used to determine the causal relationship between an intervention and its effects. However, they shouldn't be used as a substitute for explanation studies.

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

There is an encouraging increase in the number of pragmatic trials published. A recent Medline search using the words pragmatic and naturalistic, limited to randomised controlled trials (RCTs) returned 34 articles. These are shown in red on Figure 2. This is an indication that the health science community is becoming more sensitive to the subject of pragmatic thinking. It is important to keep in mind that the majority of these trials were conducted in primary care settings.