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Trials designed to inform clinical practice in the real world are referred to as pragmatic trials. They are often described as focusing on practical aspects of design that include recruitment and consent, adherence and the use of standard equipment.

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A practical trial that employs different investigators and participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This type of heterogeneity which is essential for pragmatic trials to be reliable and reduce bias in results, is also necessary. However, too much heterogeneity, can cause problems with the design of the trial.

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Pragmatic trials aim to mimic real-life situations and attain maximum external validity. They are usually commissioned by policy makers and practitioners to aid in their decision-making. They can be used to determine the causality of an intervention and its results. They should, however, not be used to replace explanation studies.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials should replace explanatory tests or if they are an addition to them. Schwartz and Lellouch1 suggested a distinction between explanatory trials, which validate the validity of a clinical or physiological hypothesis, and pragmatic trials, which guide the policy and practice of. They also proposed a framework called PRECIS for pragmatic trials.2 The tool was designed to define the traits of a pragmatic study that includes recruitment, design, delivery of the intervention, and follow-up.

The number of pragmatic trials is increasing. A recent Medline query using the keywords 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 has become more aware of the importance of pragmatism. It is important to remember that the majority of these trials were conducted in primary care settings.