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Clinical trials that are designed to help inform practice in the real world are called pragmatic trials. They are often focused on practical aspects of the study design, such as the recruitment and consent process as well as adherence to the use of standard equipment.

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Another example of a practical trial 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 essential for pragmatic trials to be reliable and lessen the chance of bias is also essential. However, too much heterogeneity, can cause problems with the trial design.

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The goal of pragmatic trials is to replicate real-life scenarios and to achieve maximum credibility externally. They are usually commissioned by policymakers and practitioners in order to guide their decisions. They are also a good way to identify the cause-effect relationship between an intervention and its outcomes. However, they should not, be used to replace explanation studies.

The concept of pragmatism is controversial and there are concerns about whether pragmatic trials should replace explanatory tests or if they should serve as an alternative to them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which confirm a physiological hypothesis or clinical hypothesis, as well as pragmatic trials that aid in the practice and policy decision-making. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the traits of a pragmatic research study that includes recruitment, design, delivery of the intervention and follow-up.

There is a growing increase in the number pragmatic trials published. A recent Medline search using the keywords pragmatic and naturalistic, restricted to controlled trials randomized to control (RCTs) resulted in 34 articles, as shown in red in Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatic thinking. However, it is important to note that the majority of these studies were conducted in primary care settings.