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Pragmatic trials are those that are designed to provide information for the real-world practice of clinical. They are often focused on practical aspects of the research design, like the recruitment process and consent as well as adherence to the use of routinely available equipment.

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Another example of a practical trial is the Home Blood Pressure Management (HBPM) study, which used various investigators and participants from various geographical areas. This type of heterogeneity, which is essential for a pragmatic trial to be reliable and reduce bias in results, is also necessary. However, too much heterogeneity could cause issues with the design of the trial.

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The aim of pragmatic trials is to replicate real-life situations and achieve maximum validity externally. They are usually ordered by policymakers and practitioners in order to guide their decisions. They are also a good method of determining the causality between an intervention and its outcomes. They should, however, not be used to replace explanation studies.

The pragmatism idea is controversial and there are concerns about whether pragmatic trials should replace explanatory trials or complement them. Schwartz and Lellouch1 suggested the distinction between explanatory trials, which prove the validity of a clinical or physiological hypothesis as well as pragmatic trials that inform policy and practice decisions. They also suggested the framework for pragmatic trials, which they called PRECIS.2 This tool sought to define the characteristics of a pragmatic trial, including recruitment, design and delivery of the intervention, and the follow-up.

There is a growing increase in the number of pragmatic trials that are published. A recent Medline query that used the words naturalistic and pragmatic, restricted to randomised controlled trials (RCTs), returned 34 articles. These are highlighted in red on Figure 2. This is a sign that the health science community is becoming increasingly sensitized to the issue of pragmatic thinking. It is important to keep in mind, however, that the majority of studies were conducted in primary-care settings.