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

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Another example of a pragmatic trial is the Home Blood Pressure Management (HBPM) study, which utilized different investigators and had participants from various geographical areas. This type of heterogeneity, which is essential for a pragmatic trial to be reliable and lessen the chance of bias is also essential. Too much heterogeneity, however, can cause problems with the trial design.

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The aim of pragmatic trials is to simulate real-life scenarios and gain the highest level of validity externally. They are usually requested by practitioners and policymakers to help inform their decisions. They are also a good way to identify the causality between an intervention and its results. However, they should not be used in lieu for the use of explanation studies.

The pragmatism concept is controversial, and there are doubts about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 suggested the distinction between explanation 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 elements of a practical study that includes recruitment, design, implementation of the intervention and follow-up.

The number of pragmatic trials is increasing. A recent Medline search using the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs) returned 34 articles. These are highlighted in red on Figure 2. This suggests that the health sciences community is becoming more aware of the importance of pragmatism. It is important to note that the majority of studies were conducted in primary-care settings.