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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 by their focus on practical aspects of designing a study, including recruitment and consent, adherence and the use of routinely available equipment.

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A practical trial that employs various investigators and participants from various geographical regions is the Home Blood Pressure Management study (HBPM). This type of heterogeneity which is essential for a pragmatic trial to be valid and to reduce bias in the results is also essential. However excessive heterogeneity could cause issues with the design of the trial.

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The goal of pragmatic trials is to replicate real-life scenarios and gain maximum validity externally. Usually, they are commissioned by policymakers and practitioners to guide their decisions. They can also be used to determine the cause-effect relationship of an intervention with its outcomes. However, they should not, be used to replace explanation studies.

The pragmatism idea is controversial, and there are questions about whether pragmatic trials should be used to replace explanatory trials or complement them. Schwartz and Lellouch1 suggested an distinction between explanation-based studies, which confirm a physiological hypothesis or clinical hypothesis, and pragmatic trials that aid in policy and practice decision-making. They also suggested a framework for pragmatic trials, called PRECIS.2 This tool sought to define the elements of a pragmatic trial that include recruitment, design and delivery of the intervention, and the follow-up.

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