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Clinical trials that are designed to help inform practice in the real world are referred to as pragmatic trials. They are often characterized as a focus on the practical aspects of study design, including the recruitment process and consent, adhering and the use routinely available equipment.

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

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The goal of pragmatic trials is to simulate real-life situations and achieve the highest level of validity externally. Usually, they are ordered by policymakers and practitioners in order to inform their decisions. They are also a good method of determining the cause-effect relationship between an intervention and its outcomes. However, they should not be used as a substitute for the use of explanation studies.

The pragmatism idea is controversial and there are doubts about whether pragmatic trials should replace tests for explanations or if they should serve as an alternative to them. Schwartz and Lellouch1 made an distinction between explanation-based studies, which prove the validity of a physiological or clinical hypothesis, and pragmatic trials, which inform the practice and policy decision-making. They also suggested a framework dubbed PRECIS for pragmatic trials.2 The tool was designed to define the characteristics of a pragmatic study which includes the recruitment, design, and delivery of the intervention and its follow-up.

There is a positive trend in the number of pragmatic trials published. A recent Medline search using the keywords naturalistic and pragmatic, which was limited to randomized controlled trials (RCTs) resulted in 34 articles, shown in red in Figure 2. This is an indication that the health science community is becoming increasingly sensitized to the subject of pragmatic thinking. However, it is important to keep in mind that the majority of these studies were conducted in primary care settings.