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Clinical trials that are designed to help inform practice in the real world are called pragmatic trials. They are often described as a focus on the practical aspects of designing a study, including the recruitment and consent process, as well as adherence 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 employed various investigators and included participants from various geographical areas. This kind of heterogeneity, which is vital for a pragmatic trial to be reliable and lessen the chance of bias is also essential. However excessive heterogeneity could cause issues with the design of the trial.

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Pragmatic trials aim to mimic real-life settings and achieve maximum external validity. They are usually requested by policy makers and practitioners to guide their decision-making. They are also a good method to determine the causal relationship between the intervention and its effects. However, they should not be used in lieu for explanatory trials.

The pragmatism concept is controversial, and there are concerns about whether pragmatic trials should replace or complement them. Schwartz and Lellouch1 proposed the distinction between explanation studies, which prove the physiological hypothesis or clinical hypothesis, and pragmatic trials, which inform the practice and policy decision-making. They also suggested a framework known as PRECIS for pragmatic trials.2 The tool was designed to define the characteristics of a pragmatic research study that includes the recruitment, design, and delivery of the intervention, and follow-up.

There is a positive increase in the number of pragmatic trials published. A recent Medline query using the keywords pragmatic and naturalistic, limited to randomised controlled trials (RCTs), returned 34 articles. These are shown in red on Figure 2. This indicates that the health science community is becoming increasingly sensitized to the subject of pragmatic thinking. It is important to keep in mind, however, that the majority were conducted in primary care settings.